Hair Transplant Expert.com

Anthony J. Mollura, M.D.
Hair Loss Specialist

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Online Evaluation

Please provide the following "required" information about yourself:

Your Name:


Phone Number:


Email Address:


Street Address:


City:


State/Province/Zip:


Country:


Your Age:

Month/Year of Birth:


Select Your Male Pattern Hair Loss:

 

OR

If female, select Baldness Type from the dropdown list below:


Comments:


(Optional) you also have the option to email Dr. Mollura a couple of photos of your head, from different angles, to better illustrate your hair loss condition. Please email your photos to hairsurg@hairtransplantexpert.com.